Strong Bones, Strong Body

By Devra Krassner, ND

Most people think of bone as hard, sturdy and never changing. Actually, this could not be further from the truth! Bones are constantly changing, being remodeled, replacing old and brittle bone with strong and healthy tissue. As we age, the rate of bone loss (resorption) out-paces the rate of formation of bone, and we become susceptible to osteopenia and osteoporosis.

What are osteopenia and osteoporosis?

Both osteopenia and osteoporosis refer to loss of bone mineral density, with osteoporosis representing the greater loss of bone mass. The significance of bone loss is that fragile bone is more susceptible to fracture. Osteoporosis-related fractures account for two million broken bones a year, according to the National Osteoporosis Foundation. A cycle of pain and immobility can significantly affect a person’s ability to function and even to survive. In fact, 12-20% of people who fracture their hips die of related complications.

The good news is that, although there are no signs and symptoms of osteoporosis, there are many steps we can take to maintain healthy bones and prevent bone loss. The first step is to assess your risk factors. Women are far more likely to develop osteoporosis, and post-menopausal women are most affected. This is because of the sudden drop of estrogen at menopause, which leads to dramatically increased bone resorption. Other risk factors include a family history of osteoporosis, smoking cigarettes, heavy alcohol use, inactivity, short and slender stature, being Caucasian or Asian, medical conditions such as rheumatoid arthritis, and certain medications.

How are they diagnosed?

Dual energy X-ray absorptiometry (DEXA) is the most accurate measure of bone density techniques now available. Low-dose radiation is used to scan the body and assess the density of representative bones. The bones most commonly measured are the spine, hip and forearm. Heel ultra-sound is a newer test that does not involve radiation, and may be a good screening test. However it is less precise than the DEXA, which remains the gold standard for evaluating bone density.

The DEXA is reported as T scores, which compare your bone density to that of a young adult of the same gender. A normal bone mineral density (BMD) is considered to be between 0 and -1. The reason it is reported in negative numbers is because it represents a bone loss. Between -1 and -2.5 standard deviations (SD) below a young adult is considered to be osteopenia. Osteoporosis is more than 2.5 SD below a young adult (2.5 or below).

In addition to the DEXA report, other factors are considered in assessing fracture risk such as blood tests, history of fracture, and the risk factors discussed previously.

What are the medical treatments for bone loss?

Bisphosphonates are the group of medications most commonly prescribed. These work by slowing the process of bone breakdown. Some of these can be taken orally (swallowed), such as Fosamax and Actonel, while others are given IV. The oral forms can cause stomach upset and heartburn, so it is recommended that they are taken with a full glass of water and that one remains upright for 30-60 minutes after taking them. Both oral and IV forms have been associated with two rare but serious conditions. The first is osteonecrosis of the jaw, which is the death of the jawbone due to lack of blood supply. The second is fracture of the femur, the long bone of the leg. There is also some controversy as to whether the bisphosphonates actually decrease the rate of fracture, or increase bone density with the formation of brittle rather than healthy bone.

Other medical treatments include estrogen and hormone-like meds such as Evista. These have become less popular due to potential risk of heart attack and certain types of cancer. Natural hormonal replacement (bio-identical hormones) is being explored as another option for prevention and treatment of osteoporosis and osteopenia.

What are natural therapies for the prevention and treatment of osteoporosis?

There are many natural therapies that can help prevent osteoporosis. It is much harder to treat osteoporosis once it has been diagnosed. However, the use of natural treatments can often slow bone loss and sometimes can even improve bone density. Healthy lifestyle and the use of vitamin and mineral supplementation play an important role in the formation and maintenance of healthy bones.

1. Nutrition

Green, leafy vegetables such as kale, broccoli, swiss chard and spinach are key to promoting bone health. These dark greens are not only a rich source of calcium, but are also high in vitamin K, boron and other micro-nutrients essential to bone health.

Soy has been found to promote bone health as well. Soy not only contains calcium, but is also a source of phytoestrogens. Phytoestrogens are components found in plants, which weakly mimic the effects of estrogen in the body. The phytoestrogens found in soy are isoflavones such as genistein and diadzein. When choosing soy products, look for organic, non-genetically modified and less refined sources of soy. Tofu, tempeh and edamame are excellent choices.

Excessive intake of animal protein has been linked to bone loss in several studies. Conversely, vegetarians seem to lose bone more slowly than people who eat more animal protein. One of the reasons that a diet high in animal protein might promote bone loss is the fact that these foods often contain high amounts of phosphorus. Phosphorus can remove calcium from the bone to create homeostasis, or balance in the bloodstream. For this same reason, it is best to avoid soda and other drinks high in phosphorus.

Fish is an exception to the connection between animal protein and bone loss. In fact, because fish is a good source of calcium and omega 3s, it is a healthy addition to one’s diet.

Reducing salt, simple sugar, caffeine, and alcohol are also part of a diet to support bone health.

2. Exercise

Exercise, especially weight-bearing exercise, is critical to maintaining healthy bones. Weight-bearing exercise includes walking, running, weight-lifting, dancing and any activity that places weight on the joints.

3. Stop smoking

In addition to healthy diet and exercise, it is extremely important to stop smoking!

Smokers lose bone more rapidly than non-smokers, and have an increased rate of hip fracture.

4. Vitamin and mineral supplementation

While it is ideal to obtain most of your nutrients from food, certain supplements are helpful, especially beginning in the pre-menopausal years.

Calcium supplementation is the first one that women usually think of. The right type, amount and balance in a calcium supplement are just as important. Some forms of calcium such as calcium citrate, malate, aspartate and apatite are more absorbable by the body, making them especially good choices. Taken in conjunction with a healthy diet, 500-750 milligrams a day of these absorbable calcium supplements should be adequate.

Vitamin D enhances the absorption of calcium in the intestines. In addition, most Northerners are deficient in vitamin D due to lack of consistent sun exposure. Cholecalciferol, or Vitamin D3, is the preferred supplement. While the amount to supplement is ideally based on a blood test for serum vitamin D, a good dose to start with is 1,000 IU a day.

Magnesium should be included with calcium and vitamin D supplementation. Magnesium is necessary for proper calcification of the bone, calcium metabolism, and supports healthy bone structure. Calcium and magnesium are usually dosed in a 2:1 ratio; therefore a calcium supplement with 500 mg would have 250 mg of magnesium. In some people, magnesium may cause loose stools, in which case they could lower the dose of magnesium.

Co-factors such as boron (2- 3 mg a day), and vitamin K2 (50-100 mcg a day) contribute to bone health. Combinations of all of these supplements are commercially available as well.

Maintaining bone health is an integral part of any healthy lifestyle. Because there are no symptoms associated with osteopenia and osteoporosis, raising our awareness about ways to prevent bone loss is especially important. Healthy bones help us to sustain our active lifestyles years beyond what has been possible in the past.